Basic Information
| Provider Information | |||||||||
| NPI: | 1073588547 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KALEN | ||||||||
| FirstName: | VICKI | ||||||||
| MiddleName: | |||||||||
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| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3402 E BROADWAY BLVD | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857165406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5208810050 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3402 E BROADWAY BLVD | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857165406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5208810050 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/20/2006 | ||||||||
| LastUpdateDate: | 03/13/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0120X | 34452 | AZ | Y | Allopathic & Osteopathic Physicians | Surgery | Pediatric Surgery |
ID Information
| ID | Type | State | Issuer | Description | 1376731851 | 01 | AZ | GROUP NPI | OTHER | 1588843734 | 01 | AZ | GROUP NPI | OTHER | 1750579439 | 01 | AZ | GROUP NPI | OTHER | 1831387315 | 01 | AZ | GROUP NPI | OTHER | 1033398201 | 01 | AZ | GROUP NPI | OTHER | 1770771255 | 01 | AZ | GROUP NPI | OTHER | 1033307715 | 01 | AZ | GROUP NPI | OTHER | 1457543324 | 01 | AZ | GROUP NPI | OTHER | Z120952 | 01 | GROUP PTAN | OTHER | Z126262 | 01 | AZ | MEDICARE PTAN | OTHER | 1740479518 | 01 | AZ | GROUP NPI | OTHER | 1871782490 | 01 | AZ | GROUP NPI | OTHER | 1396933974 | 01 | AZ | GROUP NPI | OTHER | 1447448923 | 01 | AZ | GROUP NPI | OTHER | Z126048 | 01 | AZ | GROUP PTAN | OTHER | 1780873307 | 01 | AZ | GROUP NPI | OTHER | Z126263 | 01 | AZ | MEDICARE PTAN | OTHER |